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Endocrinology > Type 1 diabetes > Flashcards

Type 1 diabetes Flashcards

1
Q

what is type 1 diabetes?

A

a state of absolute deficiency

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2
Q

how is T1DM diagnosed?

A

fasting glucose >/= 7
random >/= 11.1
symptoms
GAD/IA2 antibodies

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3
Q

which gene is associated to 50% of familial risk of T1DM?

A

HLA

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4
Q

what triggers have been associated with T1DM?

A

viral infections
maternal factors
weight gain

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5
Q

what are the 4 isle auto-antibodies (ICA)?

A

IA-2
IAA
GAD65
ZnT8

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6
Q

what is the antigen for GAD65b?

A

glutamic acid decarboxylase

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7
Q

what is the antigen for IA-2Ab

A

islet antigen 2

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8
Q

what is the antigen for IAA

A

insulin

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9
Q

what is the antigen for ZnT8Ab

A

ZnT8 transporter

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10
Q

what is the function of Glutamic acid decarboxylase?

A

GABA production

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11
Q

does glutamic acid decarboxylase increase or decrease with age?

A

increases with age

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12
Q

which sex is glutamic acid decarboxylase associated with?

A

females less than 10 yrs old

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13
Q

does islet antigen 2 increase or decrease with age?

A

decreases with age

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14
Q

what is the function of insulin?

A

regulates glucose

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15
Q

in which age group does insulin function better?

A

in children

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16
Q

what is the function of ZnT8 transporter?

A

Zn function in beta cells

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17
Q

in which age group is ZnT8 transporter better in?

A

the older

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18
Q

what are the foetal risk factors for T1DM?

A 
Maternal factors:
infection 
age 
ABO mismatch 
birth order 
stress
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19
Q

what are the disease makers that can be found in foetal life?

A

Genetics:
HLA
non-HLA

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20
Q

what are the pre-diabetes risk factors in children?

A 
Auto-immune trigger factors:
viral infecton 
Vit. D deficiency 
Dietary factors
Environmental toxins
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21
Q

what disease markers can be found in pre-diabetic stage in children?

A

auto-immune process:
autoantibodies esp. GAD 65 & IA2
candidate antigens
insulitis

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22
Q

what are the accelerating factors of T1DM?

A 
infection 
insulin resistance 
puberty 
diet/weight 
stress
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23
Q

what are the disease markers/features of clinical T1DM?

A

raised glucose
ketones
decreased insulin
decreased beta cell mass decreased C-peptide

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24
Q

what is the classic triad of presenting symptoms?

A

polyuria (enuresis in children)
polydipsia
weight loss

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25
Q

what presenting symptoms aside from the classic triad are common?

A

fatigue & somnolence
blurred vision
candidal infection
in established keto-acidosis

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26
Q

which 2 candidal infections are commonly presented with T1DM?

A

pruritis vulvae

balanitis

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27
Q

what is the first step of management in T1DM?

A 
blood glucose & ketone monitoring
insulin 
carbohydrate estimation 
regular DSN & dietitian contact 
medical clinic review
regular check of glycemic control 
annual review assessment
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28
Q

what type of insulin regimen is initially employed for T1DM?

A

basal (once daily) bolus with meal

29
Q

what can be used to check prevailing glycemic control?

A

HbA1c

30
Q

what is assessed in the annual review assessment?

A 
weight
blood pressure 
bloods: HbA1c, renal function & lipids
retinal screening 
foot risk assessment
31
Q

into which vein is insulin normally secreted?

A

the portal vein

32
Q

what rate is insulin secreted at in fasted state?

A

0.25-1.5 units of insulin per hour

33
Q

if a child is diagnosed with diabetes under the age of 6 months, is it likely to be T1DM?

A

no, more likely to have monogenic diabetes

34
Q

what is LADA?

A

latent onset diabetes of adulthood

35
Q

how is a diagnosis of LADA established?

A

by the presence of elevated levels of pancreatic auto-antiboodies in patients with recently diagnosed diabetes who do not initially require insulin

36
Q

what are the other 2 names for LADA?

A

slowly progressive Type 1

Type 1.5 diabetes

37
Q

which other genetic disease is common in diabetes?

A

cystic fibrosis

38
Q

what are the relatively common auto-immune conditions associated with diabetes in general?

A 
thyroid disease 
coeliac disease
pernicious anaemia 
addison's disease
IgA deficiency
39
Q

what are the rare auto-immune conditions associated with diabetes in general?

A

auto-immune polyglandular syndromes
AIRE mutations
IPEX syndrome

40
Q

what are the 4 devices that can be used to administer insulin?

A

syringe
disposable pen
reusable cartridge pen
continuous subcataneous insulin infusion pump

41
Q

which of the 4 devices cannot be used for self-administration of insulin?

A

syringe

42
Q

in what pattern is insulin normally secreted?

A

low basal rate continuously & spikes of post-prandial insulin

43
Q

which insulin regimen aims to mimic normal endogenous insulin production?

A

basal bolus insulin

44
Q

what is the first line insulin regimen in T1DM?

A

basal bolus insulin with patients knowing how to calculate insulin dose in relation to food

45
Q

how long does an insulin analogue take to start to work?

A

10-15 mins

46
Q

when is the peak action of insulin analogues?

A

60-90 mins

47
Q

how long id the duration of insulin analogues?

A

4-5hrs

48
Q

how long does it take for soluble insulin to start to work?

A

30-60 mins

49
Q

when is the peak action of soluble insulin?

A

2-4hrs

50
Q

how long is the duration of soluble insulin?

A

5-8 hrs

51
Q

what are the 2 types of basal insulins?

A

isophane “basal” insulins

analogue basal insulins

52
Q

what are the 2 types of fast acting insulin?

A

insulin analogues

soluble insulin

53
Q

what is the action length of isophane “basal” insulins like?

A

intermediate/long acting

54
Q

when is the peak action of isophane “basal” insulins?

A

4-6 hours after administration

55
Q

whhich of the 2 types of long acting insulin is the longest acting?

A

analogue basal insulins

56
Q

what are the components of advanced carbohydrate counting?

A

insulin to carbohydrate ratio (ICR)

insulin sensitivity factor (ISF)

57
Q

what is insulin sensitivity factor also known as?

A

correction factor (CF)

58
Q

what does an insulin pump administer?

A

continuous administration of short acting insulin - basal rate

59
Q

what must a patient using an insulin pump do before meals?

A

deliver manually activated bolus of insulin

60
Q

who is metabolic control evaluated?

A

home blood glucose monitoring
urine testing
glycated haemoglobin (Hb1Ac)
continuous glucose monitor

61
Q

what is the best way to get a clear picture of metabolic control?

A

continuous glucose monitor

62
Q

how is glycated haemoglobin formed?

A

non-enzymatic glycation of haemoglobin on exposure to gluose

63
Q

what are the problems with systems currently used to administer insulin?

A 
Insulin injection or pump
- into subcutaneous tissue
 peak too slow to prevent post-meal 
  hyperglycaemic spike
- slow clearance
64
Q

what are the factors affecting insulin absorption/action?

A

temperature
injection site
injection depth
exercise

65
Q

when is IV insulin prescribed?

A
  • DKA
  • role in hyperosmolar hyperglycaemic state
  • acute illness
  • fasting patients who are unable to tolerate oral intake
66
Q

what are the indications for a pancreas transplantation?

A

Imminent or ESRD due to receive or with kidney transplant
Severe hypoglycemia/ metabolic complications
Incapacitating clinical or emotional problems

67
Q

who is pancreatic islet transplantation usually reserved for?

A

for those with:
episodes of severe hypoglycaemia
Severe and progressive long-term complications despite maximal therapy
Uncontrolled diabetes despite maximal treatment

68
Q

what are the 4 key steps of islet transplantation?

A

pancreas donation & retrieval
islet isolation
islet culture
islet transplantation

69
Q

what must be done after an islet transplantation?

A

close follow up for 4-6 weeks

immunosuppression

Endocrinology (23 decks)

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